Healthcare Provider Details

I. General information

NPI: 1841865375
Provider Name (Legal Business Name): GARED GLAVIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
LEWISTON ME
04240-7041
US

IV. Provider business mailing address

BAYSTATE MEDICAL CENTER 759 CHESTNUT STREET
SPRINGFIELD MA
01199-0001
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-0111
  • Fax:
Mailing address:
  • Phone: 413-794-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO4116
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: